Evidence counters myth about deadly spinal taps

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A new study challenges a widely held belief that a spinal tap, a procedure safely used to treat other diseases, could suck the brain from the base of the skull and cause death in malaria patients.

The findings, published in the journal Neurology, show that the common medical procedure used to diagnose brain infections and also treat nervous system illnesses that lead to increased pressure around the brain is safe in patients with cerebral malaria.

“It’s not the spinal tap that causes death; it’s the underlying illness.”

Increased pressure in the brain can lead to death in many children who fall into a coma from cerebral malaria, which is the most severe form of the disease.

“The thought has been not to use the procedure, especially if any increased pressure in the brain or swelling seen in the eye is present in comatose malaria patients,” says Douglas Postels, a pediatric neurologist and associate professor in the College of Osteopathic Medicine at Michigan State University.

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“But based on our evidence, even children with severe brain swelling had no change in the likelihood of dying, whether or not they had a spinal tap.”

Postels, who travels to southeastern Africa to treat patients and to further his research, realized that performing a spinal tap in children with the disease was not a universal practice across the continent. Many local doctors were concerned that the procedure could force the brain out of the hole at the base of the skull because of the potential pressure difference it could cause.

Questioning the validity of this way of thinking, Postels and coauthor Christopher Moxon from the University of Liverpool set out to show that a spinal tap isn’t dangerous.

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The researchers analyzed the outcomes of 1,827 cerebral malaria patients admitted to the hospital in Malawi between 1997 and 2013. They found that children who were sicker upon arrival at the hospital were more likely to die from their illness, not from the spinal tap, which did not change their risk of death.

Based on these findings, Postels says educating the African population and other areas that have similar beliefs is crucial in treating the disease since it’s estimated that malaria kills a child on the continent every minute. “This actually is an important procedure that may help patients survive,” he says.

He hopes to further test these findings in a future randomized, controlled clinical trial to see if a spinal tap can actually be used as a therapy to lower brain pressure in children with cerebral malaria.

“The important thing to remember is it’s not the spinal tap that causes death; it’s the underlying illness. Rather than being harmful, we believe the procedure could be beneficial for these critically ill children. Anything we can do to help decrease death and disability rates for children with severe malaria is a positive for everyone.”

Source: Michigan State University